Inhale to Breathe Away Pelvic Floor Pain and Enjoy Intercourse

Pain during intercourse (dyspareunia) and involuntary contraction of the outer third of the vagina (vaginismus) affect between 6.5% and 45% of women. The behavioral approach often includes exhaling to the pain or anticipated discomfort. The common instruction is to exhale in anticipation or sensing discomfort, which paradoxically increases pelvic floor tension and discomfort. Thus, clinicians need to instruct patients to practice what seems initially counterintuitive. The appropriate breathing strategy is to teach effortless diaphragmatic (abdominal) breathing in which the pelvic floor relaxes and descends during inhalation and begin the insertion during inhalation. Do not press or insert during exhalation, and continue to breathe until the discomfort has faded out; then insert slightly more during the next inhalation phase. For clinicians, it is important to point out that this process is most successful when the person feels safe and is given enough time to allow the pelvic floor to relax as monitored by lower abdominal electromyography. This concept is illustrated in a case report of a young woman who successfully experienced intercourse after more than two years of marriage.